Veterinary Surgery最新文献

Objective: To determine the effect of the Vertek aiming device (VAD) on the surgical accuracy of navigated drilling of the distal sesamoid bone (DSB).

Study design: Experimental cadaveric study.

Sample population: A total of 30 paired equine cadaveric limbs from 15 horses.

Methods: Each specimen was placed in a purpose-built frame (PBF). Preoperative cone beam computed tomography (CBCT) images were acquired with an imaging unit coupled with a surgical navigation system. In the DSB of each specimen, a 4.5 mm glide hole and a 3.2 mm thread hole were drilled under navigation guidance, to simulate drilling for the repair of a mid-sagittal DSB fracture. In the VAD group navigated drilling was assisted by using the VAD. In the free-hand drilling group navigated drilling was performed without the VAD. Pre-and postoperative CBCT scans were merged and surgical accuracy aberrations (SAA) between the planned drill corridor and the created bone tunnel were measured. Descriptive statistics and repeated-measures analyses of variance (rep.-meas. ANOVA) were performed to compare SAA measurements between the study groups.

Results: The SAA measurements ranged from 0 to 2.9 mm in the free-hand group and from 0 to 2.8 mm in the VAD group. The median overall SAA was lower in the VAD group than in the free-hand navigated group (0.6 mm ± [0.5-0.7] vs. 0.8 mm ± [0.7-1], rep.-meas. ANOVA p = .007).

Conclusion: The additional use of the VAD in the described set-up for navigated drilling significantly improved surgical accuracy.

Clinical significance: The combined use of the VAD and PBF may help improve surgical accuracy in navigated lag screw repair of DSB fractures.

Objective: To assess the impact of a postoperative fracture gap on implant failure following radius and ulna fracture repair in toy breed dogs.

Study design: Retrospective multicenter cohort study.

Animals: A total of 80 client-owned toy breed dogs.

Methods: Medical records and radiographs were reviewed for dogs <3.5 kg that had surgical repair of simple transverse radius and ulna fractures at four institutions from 2005 to 2019. Data collected included signalment, fracture location, implant types and thickness, plate working length, evidence of a postoperative fracture gap in the caudal cortex, postoperative care, occurrence of implant failure, and other complications. The association between potential risk factors and complications was examined using multivariable logistic regression.

Results: A postoperative fracture gap in the caudal cortex was noted in 37 cases, and 10 cases experienced implant failure. Of the 43 cases without a gap, one case experienced implant failure. After adjusting for other variables, the fracture gap was significantly associated with implant failure (odds ratio = 23.0 [95% confidence interval: 2.7; 197.9], p = .004). Prolonged external coaptation was associated with minor and major complications other than implant failure (p = .04), while the absence of coaptation confounded the effects of the fracture gap on implant failure.

Conclusion and clinical significance: Reduction of the caudal cortex of the radius is imperative to promote bone healing and prevent implant failure in transverse radius and ulna fractures of toy breed dogs.

Objective: To compare the practicability and tissue sample quality between different intestinal biopsy techniques.

Study design: Experimental, randomized ex vivo study.

Sample population: Small intestine of nine horses.

Methods: Four different biopsy techniques were evaluated in the aboral jejunum and the ileum within 1 h after euthanasia. One segment was used as control (C), and the applied techniques included an 8 mm biopsy punch (BP), transverse wedge resection (TW), longitudinal wedge resection with transverse closure (LW) and a longitudinal sample using Eppendorfer biopsy forceps (EF). Defects were closed using a single-layer continuous Lembert pattern. Duration of the procedure, intestinal diameter, contamination, and bursting pressure were determined. The quality of the obtained tissue samples for histological assessment was evaluated using a semiquantitative score. The jejunal and ileal samples were analyzed separately.

Results: All biopsy procedures including defect closure were completed within 5 min, with shorter closure times for BP (p = .03). Minimal contamination could be noted in 1/8 TW and 2/8 LW cases, without significant differences between the groups. Longitudinal closure techniques (BP, EF) showed more constriction than transverse closures (TW, LW) (p < .05). Bursting pressure was >75 mmHg in all cases. Technique BP showed significantly lower biopsy quality scores (p = .009).

Conclusion: The tested biopsy techniques could all be applied effectively within a reasonable time frame, yet the biopsy punch was associated with significant artifacts and risk of missing mucosa.

Clinical significance: The findings provide insights into the possible advantages and limitations of the different techniques and alert the surgeon to potential issues with the quality of the tissue sample.

Objective: The aim of the study was to describe long-term outcomes and report post-retrieval implant analysis following cementless total knee replacement (TKR) in a dog.

Animal: A seven-year-old, male neutered, Labrador retriever.

Methods: The dog presented for evaluation of chronic left pelvic limb lameness. Orthopedic examination identified bilateral cranial drawer and medial buttress. Radiographs revealed severe bilateral osteoarthritis with moderate joint effusion/synovial hypertrophy. Given the end-stage osteoarthritis, TKR was considered more appropriate than tibial plateau leveling osteotomy (TPLO). The dog underwent a left cementless TKR.

Results: Immediate postoperative radiographs showed appropriate implant positioning. Moderate left pelvic limb lameness with full, pain free and stable stifle range of motion (ROM) was documented at 2 weeks. Increased left hindlimb weight-bearing with a peak vertical force of 70% bodyweight (BW) versus 50% BW on the contralateral leg was reported at 6 weeks. Radiographs showed good implant osseointegration. Left stifle ROM was 50°/170°, a 30° increase compared to preoperative values. Additional rechecks at 14 and 30 weeks showed gradual improvement in stifle ROM and weight-bearing. The dog was euthanized 6 years after surgery for reasons unrelated to TKR. Radiographs demonstrated static implant position without signs of osteolysis and gross examination revealed mild polyethylene wear on the caudal aspects of the tibial insert. Histological evaluation of the implant-bone interface showed extensive and robust osseointegration.

Conclusion: This case demonstrates that cementless TKR can be associated with excellent clinical function over the course of at least 6 years and suggests that early surgical intervention could be considered.

Objective: To compare the effectiveness of a modified surface gelatin sponge to a plain collagen sponge for hemostasis of parenchymal hepatic bleeding.

Study design: Prospective, randomized trial of two hemostatic agents.

Animals: A total of 45 dogs undergoing elective liver surgery were randomly allocated into two groups: 22 in the adhesive gelatin (AG) group and 23 in the plain collagen (PC) group. A total of 20 patients per group underwent liver biopsy to create a uniformly sized bleeding surface, with the remaining patients (AG = 2, PC = 3) undergoing liver lobectomy.

Methods: Evaluation of hemostatic effectiveness and tissue adhesion of each sponge type was performed by the operating surgeon using structured scoring systems. Hemostatic parameters were primarily evaluated at the liver biopsy site to maintain homogeneity of bleeding surface size.

Results: For the liver biopsy group (n = 40), 5 min after hemostatic sponge application, 10/20 dogs were bleeding in the PC group, compared to 2/20 in AG group (p = .0138). The PC bleeding was significantly higher than AG across the 3 to 6 min evaluation period (p < .001). When surgeons tested the adhesion of the sponge across the whole cohort (n = 45), AG scored 2 (of 3) against 1 for PC (p < .001). In group PC, 5/23 sponges dislodged during abdominal lavage and preparations for closure and had to be replaced due to recurrence of bleeding, compared with no AG sponges dislodging (p = .042). There were no further complications related to the use of either sponge.

Conclusion: In the dogs with hepatic parenchymal incision, use of an adhesive gelatin sponge improved intraoperative attachment and haemostatic effectiveness, compared to a collagen sponge.

Clinical significance: Based on our clinical experience in these cases, adhesive gelatin sponges could be considered an effective option when selecting a hemostatic agent for liver surgery in dogs.

Objective: To compare the reliability of respiratory function grading (RFG) scores assigned in-person and remotely via video and electronic stethoscope recordings, evaluated by novice and expert graders.

Study design: Prospective study.

Sample population: Fifty-seven brachycephalic dogs.

Methods: Dogs were evaluated in person by expert graders and RFG scores were assigned. Audio and video recordings were made during the in-person evaluations. Four expert and four novice graders evaluated the recordings and assigned an RFG score to each dog. Agreement between in-person and remote RFG scores was assessed using Cohen's kappa statistic. Interobserver reliability was assessed using Fleiss' kappa statistic.

Results: The median RFG score from the in-person assessment was 1 (range, 0-3). Distribution of RFG scores included 12 grade 0 scores, 19 grade 1 scores, 25 grade 2 scores, and 1 grade 3 score. The raw percentage agreements between remote and in-person scores were 68.4%, 59.6%, 64.9%, and 61.4% for the four experts, and 52.6%, 64.9%, 50.9%, and 42.1% for the four novices. Reliability between remote and in-person RFG scores was poor to moderate both for the experts (Cohen's kappa: .48, .37, .46, .41) and novices (Cohen's kappa: .28, .47, .28, .21). Interobserver reliability was moderate among the experts (Fleiss' kappa: .59) and poor among the novices (Fleiss' kappa: .39).

Conclusion: Remote RFG scores had poor to moderate interassessment and interobserver reliability. Novice evaluators performed worse than experts for remote or in-person RFG evaluations.

Clinical significance: Remote RFG, as measured in this study, is not reliable for assigning RFG scores. Modifications could be made to remote evaluation to improve reliability. Based upon the performance of novice evaluators, training of evaluators is justified.

Objective: The aim of this study was to describe a technique for anastomosis of the thoracic duct (TD) to the azygos vein (AV) using a microvascular anastomotic coupler (MAC) device in feline cadavers. Our hypothesis was that a TD-AV lymphaticovenous anastomosis would be feasible in feline cadavers.

Study design: Cadaveric study.

Animals: Eight domestic shorthair feline cadavers.

Methods: A left paracostal laparotomy and 9th or 10th intercostal thoracotomy was performed. Contrast media was injected into a mesenteric lymph node and lymphography was used to identify the TD and its branches. The TD and AV were isolated, ligated, and divided with the aid of a surgical microscope. The TD and AV were anastomosed end-to-end using a 1.5 or 2.0 mm MAC. Intraoperative patency was assessed by manipulation of chyle and venous blood across the anastomosis. Mesenteric lymphography was repeated to confirm postoperative anastomotic patency.

Results: The TD was identified via lymphography in seven of eight cats. The anastomosis was successful and patency was confirmed via intraoperative assessment and postoperative lymphography in all cats. The median (range) duration for the dissection and anastomosis portions of the procedure was 122 (80-150) min.

Conclusion: End-to-end anastomosis of the TD to the AV using a MAC was feasible in the feline cadaver without major intraoperative technical challenges.

Clinical significance: Anastomosis of the TD and AV may have application as an alternative treatment for idiopathic chylothorax in cats. By directly connecting the abdominal lymphatics to the central venous system, the stimulus for collateral vessel development around the site of TD ligation may be minimized, which may prevent leakage of chyle through the more cranial lymphatics.

Dogs with a brachycephalic conformation often experience a collection of abnormalities related to their craniofacial conformation, which can lead to a variety of clinical signs such as stertor, exercise intolerance, respiratory distress, and gastrointestinal signs such as regurgitation, among others. This collection of abnormalities is termed brachycephalic obstructive airway syndrome (BOAS). With the rise in popularity of several brachycephalic breeds, veterinarians and veterinary surgery specialists are seeing these dogs with increasing frequency for surgical and medical treatment of these clinical signs, leading to an increased interest in developing surgical techniques for dogs with BOAS and evaluating objective methods of determining outcome after surgery. Advances in anesthetic management including standardized protocols and use of local nerve blocks to decrease opiate use may decrease postoperative complications. A variety of new or modified surgical techniques to manage hyperplastic soft palate and stenotic nares, among other BOAS components, have been developed and studied in recent years. Newer studies have also focused on risk factors for development of major complications in the postoperative period and on objective measurements that may help determine which patients will receive the most benefit from BOAS surgery. In this review, the newest studies focused on updates in anesthetic management, surgical techniques, and postoperative care will be discussed. Additionally, updated information on complication rates and outcomes for dogs undergoing surgical management of BOAS will be included.

Objective: The aim of the present study was to investigate the long-term survival and postoperative complications in horses that had undergone small intestinal resection and a modified anastomosis technique using a partially stapled, functional end-to-end anastomosis.

Study design: Observational retrospective case series.

Animals: A total of 25 horses underwent small intestinal resection and a partially stapled, functional end-to-end anastomosis.

Methods: A modified technique to create a partially stapled, functional end-to-end anastomosis is described. The clinical case records of all horses that fulfilled the criteria between January 1, 2010 and January 1, 2020 were reviewed. Data on short-term survival and postoperative complications were collated. A telephone questionnaire of owners was undertaken to evaluate long-term survival.

Results: Duration of follow up was from one to 4232 days (median 785 days). A total of 21/25 (84%) of horses survived to discharge, 19/25 (76%) horses were alive at 6 and 12 months and 64% survived to 2 years. A total of 64% of horses developed at least one postoperative complication. Two horses developed a small intestinal volvulus necessitating repeat laparotomy. One horse had kinking at the anastomosis site diagnosed at post-mortem examination.

Conclusion: Partially stapled functional end-to-end anastomosis technique in this study had similar short- and long-term survival to those reported in previous studies using handsewn techniques, but severe complications at the anastomosis site occurred in >10% of cases.

Clinical relevance: The anastomosis technique described appears to have similar short- and long-term survival and complication rates, compared to more commonly used anastomosis techniques. However, there is potential for severe complications at the anastomosis site.

Objective: To report the outcomes of cats that underwent surgical correction for sialoceles.

Study design: Multi-institutional retrospective cohort study.

Animals: Twenty-one client-owned cats.

Methods: Medical records were examined of cats diagnosed with sialocele, which underwent surgical intervention over an 11-year period at one of 10 referral hospitals. The data collected included signalment, clinical signs, diagnostic imaging, histopathology, surgical procedures performed, and postoperative complications.

Results: The most common presenting complaints for cats with sialocele included dysphagia and ptyalism. Only two cats had a recent history of trauma, and one was diagnosed with a concurrent sialolith. Most displayed visible tissue swelling, with ranulae being most common. Surgical treatment consisted of sialoadenectomy and/or marsupialization. Intraoperative complications occurred in three cats, and postoperative complications in five cats. No recurrence or development of contralateral sialoceles were reported during the follow-up period (30-968 days).

Conclusion: The majority of cats did not have a clear underlying cause for developing a sialocele. The sublingual and mandibular salivary glands were presumed to be the most commonly affected. Mandibular and sublingual sialoadenectomy and/or marsupialization provided resolution of clinical signs to the 21 cats that underwent these procedures.

Clinical significance: Sialocele, although rare, should remain a differential diagnosis when managing cats with relevant clinical signs. Surgical intervention appears to offer resolution of signs with apparently low overall risk of complication or short-term recurrence. In cats it is necessary to evaluate whether sialoadenectomy is necessary, or whether marsupialization alone should be attempted as a less invasive first-line surgical intervention.